Computer-assisted teleoperated surgery systems and methods

ABSTRACT

A teleoperated manipulator system includes a manipulator assembly and a tool actuation assembly coupled to the manipulator assembly. The tool actuation assembly inserts a tool, such as a surgical instrument, along an insertion axis and also rotates the tool around the insertion axis. The manipulator assembly includes an arm that rotates with reference to a mounting base to rotate the tool around a yaw axis that intersects the insertion axis. A distal portion of the arm defines an arcuate pitch arc, and a center of the pitch arc is coincident with the intersection of the insertion axis and the yaw axis. The tool actuation assembly is driven along the pitch arc to pitch the tool. The manipulator system is optionally a telesurgical system, and the tool is optionally a therapeutic, diagnostic, or imaging surgical instrument.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of and claims the benefit of priorityto U.S. patent application Ser. No. 16/326,851, filed Feb. 20, 2019,which is a National Stage Application under 35 U.S.C. § 371 and claimsthe benefit of International Application No. PCT/US2017/055130, filedOct. 4, 2017, which claims the benefit of priority to U.S. ProvisionalPatent Application No. 62/404,069 (filed Oct. 4, 2016), the disclosuresof which are incorporated herein by reference.

COPYRIGHT NOTICE

A portion of the disclosure of this patent document contains materialwhich is subject to copyright protection. The copyright owner has noobjection to the facsimile reproduction by anyone of the patent documentor the patent disclosure, as it appears in the Patent and TrademarkOffice patent file or records, but otherwise reserves all copyrightrights whatsoever.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

Not Applicable.

BACKGROUND

Teleoperated surgical systems (often called “robotic” surgical systemsbecause of the use of robot technology) and other computer-assisteddevices often include one or more tool manipulators to manipulatediagnostic or therapeutic tools for performing a task at a surgical worksite and at least one manipulator for supporting an image capturing toolwhich captures images of the surgical work site. A manipulator armcomprises a plurality of links coupled together by one or more activelycontrolled joints. In many embodiments, a plurality of activelycontrolled joints may be provided. The robot arm may also include one ormore passive joints, which are not actively controlled, but which complywith movement of an actively controlled joint. Such active and passivejoints may be various types, including revolute and prismatic joints.The kinematic pose of the manipulator arm may be determined by thepositions of the joints and knowledge of the structure and coupling ofthe links and the application of known kinematic calculations.

Minimally invasive telesurgical systems for use in surgery are beingdeveloped to increase a surgeon's dexterity as well as to allow asurgeon to operate on a patient from a remote location. Telesurgery is ageneral term for surgical systems in which the surgeon uses some form ofremote control, e.g., a servomechanism, or the like, to manipulatesurgical tool movements rather than directly holding and moving thetools by hand. In such a telesurgery system, the surgeon is providedwith an image of the surgical site at the remote location. While viewingtypically a stereoscopic image of the surgical site that provides theillusion of depth on a suitable viewer or display, the surgeon performsthe surgical procedures on the patient by manipulating master controlinput devices, which in turn control the motion of correspondingteleoperated tools. The teleoperated surgical tools can be insertedthrough small, minimally invasive surgical apertures or natural orificesto treat tissues at surgical sites within the patient, often avoidingthe trauma generally associated with accessing a surgical worksite byopen surgery techniques. These computer-assisted tele-operated systemscan move the working ends (end effectors) of the surgical tools withsufficient dexterity to perform quite intricate surgical tasks, often bypivoting shafts of the tools at the minimally invasive aperture, slidingof the shaft axially through the aperture, rotating of the shaft withinthe aperture, and the like.

SUMMARY

The following summary introduces certain aspects of the inventivesubject matter in order to provide a basic understanding. This summaryis not an extensive overview of the inventive subject matter, and it isnot intended to identify key or critical elements or to delineate thescope of the inventive subject matter. Although this summary containsinformation that is relevant to various aspects and embodiments of theinventive subject matter, its sole purpose is to present some aspectsand embodiments in a general form as a prelude to the more detaileddescription below.

In one aspect, a teleoperated manipulator system includes a mountingbase and an arm attached to the mounting base at a rotational joint. Thearm rotates around a yaw axis with reference to the mounting base. Adistal portion of the arm defines a pitch arc. A tool actuator assemblyis mounted to a tool actuator assembly coupling that translates alongthe pitch arc. The tool actuation assembly is driven along the pitch arcto move around a center of the pitch arc that is coincident with the yawaxis. The tool actuation assembly inserts a tool along an insertion axisthat intersects the yaw axis where the center of the pitch arc iscoincident with the yaw axis.

In another aspect, the distal portion of the arm includes a fixedarcuate segment and a movable arcuate segment that telescopes withreference to the fixed arcuate segment. As the tool actuation assemblymoves along the pitch arc, the tool actuation assembly coupling movesalong the movable arcuate segment, and the movable arcuate segment movesalong the fixed arcuate segment.

In further aspects, this disclosure provides devices and methods forminimally invasive robotic surgery using a computer-assistedteleoperated surgery system (a “telesurgical system”). For example, thisdisclosure provides manipulators for a telesurgical system. In someembodiments, each manipulator includes an arm that is rotatably coupledabout a yaw axis to a mounting base that is attachable to a set-upstructure. The arm defines an arcuate path along which a tool actuatorassembly coupling travels. The tool actuator assembly coupling canreceive a surgical tool actuation assembly pod, and it can drive arotary roll motion of the pod about an insertion axis. In someembodiments, the insertion axis and the yaw axis intersect each other ata point that is coincident with the arcuate path's center point. In someembodiments, a motor-driven link is used to drive the tool actuatorcoupling along the arcuate path.

In one aspect, this disclosure is directed to a telesurgical manipulatorthat includes a mounting base configured to releasably couple with aset-up structure of a telesurgical system; an arm rotatably coupled tothe mounting base about a yaw axis, the arm defining a pitch arc; antool actuator assembly coupling defining an insertion axis andconfigured to releasably couple with a teleoperated tool actuatorassembly, the tool actuator coupling translatable along the pitch arc;and a link pivotably coupled to the tool actuator coupling and movablycoupled to the arm such that the link is translatable along the arm.

Such a telesurgical manipulator may optionally include one or more ofthe following features. The insertion axis and the yaw axis mayintersect each other at a center of the pitch arc. In some embodiments,at all positions of the tool actuator coupling along the pitch arc, theinsertion axis and the yaw axis intersect may each other at a center ofthe pitch arc. In particular embodiments, at all positions about the yawaxis of the arm relative to the mounting base, the insertion axis andthe yaw axis may intersect each other at a center of the pitch arc. Insome embodiments, at all positions of the tool actuator assemblycoupling along the pitch arc in combination with any position about theyaw axis of the arm relative to the mounting base, the insertion axisand the yaw axis intersect each other at a center of the pitch arc.Translation of the link along the arm causes curvilinear translation ofthe tool actuator coupling along the pitch arc. The link may bethreadably coupled to a lead screw of the arm such that the arm islinearly translatable along the arm by rotation of the lead screw.Translation of the link along the arm causes curvilinear translation ofthe tool actuator assembly coupling along the pitch arc. The arm mayinclude a pitch-adjustment motor that drives rotation of the lead screw.The tool actuator assembly coupling may include a roll-adjustment motorfor rotatably driving a surgical tool actuator assembly about theinsertion axis. The tool actuator assembly coupling may be configured toreleasably couple with a cannula configured for providing surgicalaccess through a patient's body wall during surgery using thetelesurgical manipulator. The arm may include a projection extendinginto an internal space defined by the mounting base. The projection maydefine the yaw axis. The mounting base may include a sector gear affixedin a stationary relationship to the mounting base. The arm may include ayaw-adjustment motor that rotatably drives a yaw-adjustment gear meshedwith the sector gear. The arm may include a fixed arcuate segment and amovable arcuate segment that is movably coupled with the fixed arcuatesegment. The first arcuate segment in combination with the movablearcuate segment may define the pitch arc.

In another aspect, this disclosure is directed to a telesurgicalmanipulator including: a mounting base; an arm rotatably coupled to themounting base; a tool actuator assembly coupling movably coupled to thearm such that the tool actuator assembly coupling is translatablerelative to the arm, the tool actuator coupling configured to releasablycouple with a telesurgical tool actuator assembly; and a link movablycoupled between the tool actuator assembly coupling and the arm.

Such a telesurgical manipulator device may optionally include one ormore of the following features. The link may be pivotably coupled to thetool actuator assembly and threadably coupled to the arm. The toolactuator assembly coupling may be translatable along an arc defined bythe arm. The arm may include a fixed arcuate segment and a movablearcuate segment that is movably coupled with the fixed arcuate segment.The first arcuate segment in combination with the movable arcuatesegment may define the pitch arc. The arm may define an elongate openingin which the tool actuator coupling is translatable along a curvilinearpath.

In another aspect, this disclosure is directed to a telesurgical systemincluding: a set-up structure releasably coupleable with a frame; amanipulator device; and a telesurgical tool actuator assembly releasablycoupleable with the tool actuator assembly coupling. The tool actuatorassembly coupling includes a roll-adjustment motor for rotatably drivingthe surgical tool actuator assembly about the insertion axis. Themanipulator device includes: a mounting base releasably coupleable withthe set-up structure; an arm rotatably coupled to the mounting base; atool actuator assembly coupling movably coupled to the arm such that thetool actuator assembly coupling is translatable relative to the arm, thetool actuator assembly coupling defining an insertion axis; and a linkmovably coupled between the tool actuator assembly coupling and the arm.

Such a telesurgical system may optionally include one or more of thefollowing features. In some embodiments, an entirety of the toolactuator assembly is rotatably drivable by the roll-adjustment motor. Arotatable coupling between the arm and the mounting base defines a yawaxis. The arm defines a pitch arc along which the tool actuator assemblycoupling translates. The insertion axis and the yaw axis intersect eachother at a center of the pitch arc. The arm may include a fixed arcuatesegment and a movable arcuate segment that is movably coupled with thefixed arcuate segment. The first arcuate segment in combination with themovable arcuate segment define the pitch arc.

Some or all of the embodiments described herein may provide one or moreof the following advantages. In some cases, the teleoperated manipulatordevices provided herein are advantageously structured to have a lowprofile, i.e., to be spatially-compact. Such a compact configuration isadvantageous in that the working space occupied by the teleoperatedsurgical manipulators above a patient is minimized, allowing forenhanced patient access by surgical personnel. Additionally, greatervisualization of the patient and communications between surgical teammembers is facilitated by the compact manipulator working space.

Further, lessening the size of the manipulator working space can reducethe potential for collisions between manipulators. As a result, the needfor redundant degrees of freedom of the manipulators is reduced oreliminated. Hence, the complexity of the manipulators can be lessened insome cases.

The compact size of teleoperated surgical manipulators described hereincan also advantageously facilitate mounting the manipulators to a railof an operating table in some cases. In such a case, as the operatingtable is manipulated to enhance surgical access, the table-mountedmanipulator devices inherently follow. Therefore, the need to repositionthe manipulators in response to movements of the operating table isadvantageously reduced or eliminated.

In addition, the teleoperated surgical manipulators described herein areadvantageously structured to have a relatively low mass and inertia. Inaddition, the mass distribution is substantially constant such that theinertia is substantially constant, and therefore predictable.

The details of one or more embodiments are set forth in the accompanyingdrawings and the description below. Other features, objects, andadvantages will be apparent from the description and drawings, and fromthe claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an example manipulation subsystem of atelesurgical system.

FIG. 2 is a front view of an example user control subsystem of atelesurgical system.

FIG. 3 is a side view of an example telesurgical system manipulator armassembly.

FIG. 4 is a perspective view of another type of manipulation subsystemof a telesurgical system.

FIG. 5 is a perspective view of a distal end portion of an examplesurgical tool in a first configuration.

FIG. 6 is a perspective view of the distal end portion of the surgicaltool of FIG. 5 in a second configuration.

FIG. 7 is a perspective view of the distal end portion of the surgicaltool of FIG. 5 in a third configuration.

FIG. 8 is a perspective view depicting a surgical tool coupled with asurgical tool actuation assembly pod that is mounted to an exampletelesurgical manipulator assembly in accordance with some embodiments.

FIG. 9 is a perspective view of an example surgical tool actuationassembly pod in accordance with some embodiments.

FIG. 10 is a perspective view of an example telesurgical systemmanipulator in accordance with some embodiments.

FIG. 11 is a partially transparent view corresponding to FIG. 10.

FIG. 12 is a side view of the telesurgical system manipulator of FIG.10.

FIG. 13 is a partially transparent view corresponding to FIG. 12.

FIG. 14 is a top view of the telesurgical system manipulator of FIG. 10.

FIG. 15 is a partially transparent view corresponding to FIG. 14.

FIGS. 16 and 17 are partially transparent perspective views of thetelesurgical system manipulator of FIG. 10 that illustrate yaw motionsof the manipulator.

FIGS. 18-20 are partially transparent perspective views of thetelesurgical system manipulator of FIG. 10 that illustrate pitch motionsof the manipulator.

FIG. 21 is a perspective view depicting a surgical tool coupled with asurgical tool actuation assembly pod that is mounted to another exampletelesurgical system manipulator in accordance with some embodiments.

FIGS. 22-24 are partially transparent perspective views of thetelesurgical system manipulator of FIG. 21 that illustrate pitch motionsof the manipulator.

DETAILED DESCRIPTION

This description and the accompanying drawings that illustrate inventiveaspects, embodiments, implementations, or applications should not betaken as limiting—the claims define the protected invention. Variousmechanical, compositional, structural, electrical, and operationalchanges may be made without departing from the spirit and scope of thisdescription and the claims. In some instances, well-known circuits,structures, or techniques have not been shown or described in detail inorder not to obscure the invention. Like numbers in two or more figuresrepresent the same or similar elements.

Further, specific words chosen to describe one or more embodiments andoptional elements or features are not intended to limit the invention.For example, spatially relative terms—such as “beneath”, “below”,“lower”, “above”, “upper”, “proximal”, “distal”, and the like—may beused to describe one element's or feature's relationship to anotherelement or feature as illustrated in the figures. These spatiallyrelative terms are intended to encompass different positions (i.e.,translational placements) and orientations (i.e., rotational placements)of a device in use or operation in addition to the position andorientation shown in the figures. For example, if a device in thefigures is turned over, elements described as “below” or “beneath” otherelements or features would then be “above” or “over” the other elementsor features. Thus, the exemplary term “below” can encompass bothpositions and orientations of above and below. A device may be otherwiseoriented (e.g., rotated 90 degrees or at other orientations) and thespatially relative descriptors used herein interpreted accordingly.Likewise, descriptions of movement along (translation) and around(rotation) various axes includes various special device positions andorientations. The combination of a body's position and orientationdefine the body's pose.

Similarly, geometric terms, such as “parallel”, “perpendicular”,“round”, or “square”, are not intended to require absolute mathematicalprecision, unless the context indicates otherwise. Instead, suchgeometric terms allow for variations due to manufacturing or equivalentfunctions. For example, if an element is described as “round” or“generally round”, a component that is not precisely circular (e.g., onethat is slightly oblong or is a many-sided polygon) is still encompassedby this description. The words “including” or “having” mean includingbut not limited to.

It should be understood that although this description is made to besufficiently clear, concise, and exact, scrupulous and exhaustivelinguistic precision is not always possible or desirable, since thedescription should be kept to a reasonable length, and skilled readerswill understand background and associated technology. For example,considering a video signal, a skilled reader will understand that anoscilloscope described as displaying the signal does not display thesignal itself but a representation of the signal, and that a videomonitor described as displaying the signal does not display the signalitself but video information the signal carries.

In addition, the singular forms “a”, “an”, and “the” are intended toinclude the plural forms as well, unless the context indicatesotherwise. And, the terms “comprises”, “includes”, “has”, and the likespecify the presence of stated features, steps, operations, elements,and/or components but do not preclude the presence or addition of one ormore other features, steps, operations, elements, components, and/orgroups. And, the or each of the one or more individual listed itemsshould be considered optional unless otherwise stated, so that variouscombinations of items are described without an exhaustive list of eachpossible combination. The auxiliary verb may likewise imply that afeature, step, operation, element, or component is optional.

Elements described in detail with reference to one embodiment,implementation, or application optionally may be included, wheneverpractical, in other embodiments, implementations, or applications inwhich they are not specifically shown or described. For example, if anelement is described in detail with reference to one embodiment and isnot described with reference to a second embodiment, the element maynevertheless be claimed as included in the second embodiment. Thus, toavoid unnecessary repetition in the following description, one or moreelements shown and described in association with one embodiment,implementation, or application may be incorporated into otherembodiments, implementations, or aspects unless specifically describedotherwise, unless the one or more elements would make an embodiment orimplementation non-functional, or unless two or more of the elementsprovide conflicting functions.

Elements described as coupled may be electrically or mechanicallydirectly coupled, or they may be indirectly coupled via one or moreintermediate components.

The term “flexible” in association with a part, such as a mechanicalstructure, component, or component assembly, should be broadlyconstrued. In essence, the term means the part can be repeatedly bentand restored to an original shape without harm to the part. Many “rigid”objects have a slight inherent resilient “bendiness” due to materialproperties, although such objects are not considered “flexible” as theterm is used herein. A flexible part may have infinite degrees offreedom (DOF's). Examples of such parts include closed, bendable tubes(made from, e.g., NITINOL, polymer, soft rubber, and the like), helicalcoil springs, etc. that can be bent into various simple or compoundcurves, often without significant cross-sectional deformation. Otherflexible parts may approximate such an infinite-DOF part by using aseries of closely spaced components that are similar to a snake-likearrangement of serial “vertebrae”. In such a vertebral arrangement, eachcomponent is a short link in a kinematic chain, and movable mechanicalconstraints (e.g., pin hinge, cup and ball, live hinge, and the like)between each link may allow one (e.g., pitch) or two (e.g., pitch andyaw) DOF's of relative movement between the links. A short, flexiblepart may serve as, and be modeled as, a single mechanical constraint(joint) that provides one or more DOF's between two links in a kinematicchain, even though the flexible part itself may be a kinematic chainmade of several coupled links. Knowledgeable persons will understandthat a part's flexibility may be expressed in terms of its stiffness.

Unless otherwise stated in this description, a flexible part, such as amechanical structure, component, or component assembly, may be eitheractively or passively flexible. An actively flexible part may be bent byusing forces inherently associated with the part itself. For example,one or more tendons may be routed lengthwise along the part and offsetfrom the part's longitudinal axis, so that tension on the one or moretendons causes the part or a portion of the part to bend. Other ways ofactively bending an actively flexible part include, without limitation,the use of pneumatic or hydraulic power, gears, electroactive polymer(more generally, “artificial muscle”), and the like. A passivelyflexible part is bent by using a force external to the part (e.g., anapplied mechanical or electromagnetic force). A passively flexible partmay remain in its bent shape until bent again, or it may have aninherent characteristic that tends to restore the part to an originalshape. An example of a passively flexible part with inherent stiffnessis a plastic rod or a resilient rubber tube. An actively flexible part,when not actuated by its inherently associated forces, may be passivelyflexible. A single part may be made of one or more actively andpassively flexible parts in series.

Inventive aspects are associated with computer-assisted teleoperatedsurgical systems. An example of a teleoperated surgical system is a daVinci® Surgical System, commercialized by Intuitive Surgical, Inc. ofSunnyvale, Calif. Knowledgeable persons will understand that inventiveaspects disclosed herein may be embodied and implemented in variousways, including completely computer-assisted and hybrid combinations ofmanual and computer-assisted embodiments and implementations. Asapplicable, inventive aspects may be embodied and implemented in bothrelatively smaller, hand-held, hand-operated devices and relativelylarger systems that have additional mechanical support, as well as inother embodiments of computer-assisted teleoperated medical devices. Inaddition, inventive aspects are associated with advances incomputer-assisted surgical systems that include autonomous rather thanteleoperated actions, and so both teleoperated and autonomous surgicalsystems are included, even though the description concentrates onteleoperated systems.

A computer is a machine that follows programmed instructions to performmathematical or logical functions on input information to produceprocessed output information. A computer includes a logic unit thatperforms the mathematical or logical functions, and memory that storesthe programmed instructions, the input information, and the outputinformation. The term “computer” and similar terms, such as “processor”or “controller” or “control system”, encompasses both centralizedsingle-location and distributed implementations.

This disclosure provides improved surgical and telesurgical devices,systems, and methods. The inventive concepts are particularlyadvantageous for use with telesurgical systems in which a plurality ofsurgical tools are mounted on and moved by an associated plurality ofteleoperated manipulators during a surgical procedure. The teleoperatedsurgical systems will often comprise telerobotic, telesurgical, and/ortelepresence systems that include one or more processors configured asmaster-slave controllers. By providing teleoperated surgical systemsemploying processors appropriately configured to move manipulatorassemblies with articulated linkages having relatively large numbers ofdegrees of freedom, the motion of the linkages can be tailored for workthrough a minimally invasive access site. The large number of degrees offreedom may also allow a processor to position the manipulators toinhibit interference or collisions between these moving structures, andthe like.

The manipulator assemblies described herein will often include ateleoperated manipulator and a tool mounted thereon (the tool oftencomprising a surgical instrument in surgical versions), although theterm “manipulator assembly” will also encompass the manipulator withoutthe tool mounted thereon. The term “tool” encompasses both general orindustrial robotic tools and specialized robotic surgical instruments,with surgical instruments often including an end effector that issuitable for manipulation of tissue, treatment of tissue, imaging oftissue, or the like. The tool/manipulator interface will often be aquick disconnect tool holder or coupling, allowing rapid removal andreplacement of the tool with an alternate tool. The manipulator assemblywill often have a base that is fixed in space during at least a portionof a telesurgical procedure, and the manipulator assembly may include anumber of degrees of freedom between the base and an end effector of thetool. Actuation of the end effector (such as opening or closing of thejaws of a gripping device, energizing an electrosurgical paddle, or thelike) will often be separate from, and in addition to, these manipulatorassembly degrees of freedom.

The end effector will typically move in the workspace with between twoand six degrees of freedom. As used herein, the term “pose” encompassesboth position and orientation. Hence, a change in a pose of an endeffector (for example) may involve a translation of the end effectorfrom a first position to a second position, a rotation of the endeffector from a first orientation to a second orientation, or acombination of both. As used herein, the term “end effector” thereforeincludes but is not limited to the function of changing the orientationor position (e.g., a “wrist” function, a parallel motion function) ofits distal-most part or parts (e.g., jaw(s) and the like).

When used for minimally invasive teleoperated surgery, movement of themanipulator assembly is controlled by a processor of the system so thata shaft or intermediate portion of the tool is constrained to a safemotion through a minimally invasive surgical access site or otheraperture. Such motion may include, for example, axial insertion of theshaft along its long axis through the aperture site, rotation of theshaft about its long axis, and pivotal motion of the shaft about a pivotpoint (a remote center of motion) on its long axis that is adjacent theaccess site. But, such motion will often preclude excessive lateralmotion of the shaft at the aperture site that might otherwise tear thetissues adjacent the aperture or enlarge the access site inadvertently.Some or all of such constraint on the manipulator motion at the accesssite may be imposed by using mechanical manipulator joint linkages thatinhibit undesired motions (i.e., the hardware constrains motion at theremote center of motion), or the constraint may in part or in full byusing robotic data processing and control techniques (i.e., softwarecontrol constrains motion at the remote center of motion). Hence, suchminimally invasive aperture-constrained motion of the manipulatorassembly may employ between zero and three degrees of freedom of themanipulator assembly.

Many of the exemplary manipulator assemblies described herein will havemore degrees of freedom than are needed to pose and move an end effectorwithin a surgical site in Cartesian space (e.g., 7, 8, 9, 10, or more).For example, a manipulator assembly that can move a surgical endeffector in six degrees of freedom in Cartesian space at an internalsurgical site through a minimally invasive aperture optionally may havenine degrees of freedom (six end effector degrees of freedom—three forposition, and three for orientation—plus three additional manipulatorassembly degrees of freedom to comply with access site constraints,collision avoidance, etc.). Highly configurable manipulator assemblieshaving more degrees of freedom than are needed for a given end effectorpose can be described as having or providing sufficient degrees offreedom to allow a range of joint states for an end effector pose in aworkspace. For example, for a given end effector position, themanipulator assembly may occupy (and be driven between) any of a rangeof alternative manipulator linkage poses. Similarly, for a given endeffector velocity vector, the manipulator assembly may have a range ofdiffering joint movement speeds for the various joints of themanipulator assembly.

Referring to FIGS. 1 and 2, telesurgical systems optionally include amanipulating subsystem 100 (e.g., a patient-side unit) and a usercontrol subsystem 40 (e.g., a surgeon control console) at which commandsare entered to control tool motion in the manipulating subsystem 100.

In the depicted embodiment, the manipulating subsystem 100 includes abase 110, a first manipulator arm assembly 120, a second manipulator armassembly 130, a third manipulator arm assembly 140, and a fourthmanipulator arm assembly 150. As shown, the base 110 includes a portionthat rests on the floor, a vertical column that extends vertically fromthe base, and a horizontal boom that extends from the top of the column.Other base configurations to mechanically ground the patient-side unitmay optionally be used (e.g., ceiling-, wall-, table-mounted, etc.).Each manipulator arm assembly 120, 130, 140, and 150 is pivotablycoupled to the base 110. In some embodiments, fewer than four or morethan four robotic manipulator arm assemblies may be included as part ofthe manipulating subsystem 100. While in the depicted embodiment thebase 110 includes casters to allow ease of mobility, in some embodimentsthe manipulating subsystem 100 is fixedly mounted to a floor, ceiling,operating table, structural framework, or the like.

In a typical application, two of the manipulator arm assemblies 120,130, 140, or 150 each hold a surgical tool, and a third or themanipulator arm assemblies 120, 130, 140, or 150 holds a stereoscopicendoscope. The remaining manipulator arm assembly is available so thatanother tool may be introduced at the work site. Alternatively, theremaining manipulator arm assembly may be used for introducing a secondendoscope or another image capturing device, such as an ultrasoundtransducer, to the work site.

Each of the manipulator arm assemblies 120, 130, 140, and 150 includeslinks that are coupled together and manipulated through actuatable(motorized) joints. Each of the manipulator arm assemblies 120, 130,140, and 150 includes a setup arm portion and a manipulator. The setuparm portion holds the manipulator to place the manipulator's remotecenter of motion where the tool enters the patient's body at an incisionor natural orifice. The device manipulator may then manipulate its tool;so that it may be pivoted about the remote center of motion, insertedinto and retracted out of the entry aperture, and rotated about itslongitudinal shaft axis.

In the depicted embodiment, the user control subsystem 40 includes astereo vision display 45 so that the user may view the surgical worksite in stereoscopic vision from images captured by the stereoscopiccamera of the manipulating subsystem 100. Left and right eyepieces 46and 47 are provided in the stereo vision display 45 so that the user mayview left and right display screens inside the display 45 respectivelywith the user's left and right eyes. While viewing typically an image ofthe surgical site on a suitable viewer or display, the surgeon performsa surgical procedure on the patient by controlling one or more masterinput devices, which in turn control the motion of corresponding toolsin the manipulating subsystem.

The user control subsystem 40 also includes left and right master inputdevices 41, 42 that the user may grasp respectively with the left andright hands to manipulate tools held by the manipulator arm assemblies120, 130, 140, and 150 of the manipulating subsystem 100 in preferablysix or more degrees-of-freedom (“DOF”). Foot pedals 44 are provided onthe user control subsystem 40 so the user may control movement and/oractuation of devices associated with the foot pedals. Additional inputto the system may be made via one or more other inputs, such as buttons,touch pads, voice, and the like, as illustrated by input 49.

A processor 43 is provided in the user control subsystem 40 for controland other purposes. The processor 43 performs various functions in thetelesurgical system. One function performed by processor 43 is totranslate and transfer the mechanical motion of master input devices 41,42 to actuate their respective joints in their corresponding manipulatorarm assemblies 120, 130, 140, and 150 so that the user can effectivelymanipulate tools, such as the surgical tools and endoscopic camera.Another function of the processor 43 is to implement the methods,cross-coupling control logic, and controllers described herein.

Although described as a processor, it is to be appreciated that theprocessor 43 may be implemented by any combination of hardware,software, and firmware. Also, its functions as described herein may beperformed by one unit or divided up among a number of subunits, each ofwhich may be implemented in turn by any combination of hardware,software, and firmware. Further, although being shown as part of orbeing physically adjacent to the surgeon control unit 40, the processor43 may also be distributed as subunits throughout the telesurgerysystem. Accordingly, control aspects referred to herein are implementedvia processor 43 in either a centralized or distributed form.

Referring to FIG. 3, the robotic manipulator arm assemblies 120, 130,140, and 150 can manipulate tools such as surgical tools to performminimally invasive surgery. For example, in the depicted arrangement themanipulator arm assembly 120 includes an tool holder assembly 122. Acannula 180 and a surgical tool 200 and are, in turn, releasably coupledto the tool holder assembly 122. The cannula 180 is a tubular memberthat is located at the patient interface site during a surgery. Thecannula 180 defines a lumen in which an elongate shaft 220 of thesurgical tool 200 is slidably disposed.

The tool holder assembly 122 includes a spar 124, a cannula clamp 126,and a tool carriage 128. In the depicted embodiment, the cannula clamp126 is fixed to a distal end of the spar 124. The cannula clamp 126 canbe actuated to couple with, or to uncouple from, the cannula 180. Thetool holder carriage 128 translates linearly along spar 124 to move atool coupled to carriage 128 proximally (withdraw) or distally (insert).The movement of the tool holder carriage 128 along spar 124 iscontrolled by the processor 43, in part while a master control input iscontrolling insertion and withdrawal movements of the tool. As shown,tool holder carriage 128 includes electric motors that drive mechanicalinputs on tool 200 that control end effector and other componentmovements.

The surgical tool 200 includes a transmission assembly 210, the elongateshaft 220, and an end effector 230. The transmission assembly 210 isreleasably coupleable with the tool holder carriage 128. The shaft 220extends distally from the transmission assembly 210. The end effector230 is disposed at a distal end of the shaft 220.

The shaft 220 defines a longitudinal axis 222 that is coincident with alongitudinal axis of the cannula 180. As the tool holder carriage 128translates along the spar 124, the elongate shaft 220 of the surgicaltool 200 is moved along the longitudinal axis 222. In such a manner, theend effector 230 can be inserted and/or retracted from a surgicalworkspace within the body of a patient.

Also referring to FIG. 4, another example manipulating subsystem 160 fortelesurgery includes a first manipulator arm assembly 162 and a secondrobotic manipulator arm assembly 164 that are each mounted to anoperating table 10. In some cases, this configuration of manipulatingsystem 160 can be used as an alternative to the manipulating subsystem100 of FIG. 1. While only two manipulator arm assemblies 162 and 164 aredepicted, it should be understood that one, or more than two (e.g.,three, four, five, six, and more than six) manipulator arm assembliescan be included in some configurations.

In some cases, the operating table 10 may be moved or reconfiguredduring surgery. For example, in some cases, the operating table 10 maybe tilted about various axes, raised, lowered, pivoted, rotated, and thelike. In some cases, by manipulating the orientation of the operatingtable 10, a clinician can utilize the effects of gravity to positioninternal organs of the patient in positions that facilitate enhancedsurgical access (i.e., gravity retraction). In some cases, suchmovements of the operating table 10 may be integrated as a part of thetelesurgical system and controlled by the system.

Also referring to FIGS. 5-7, a variety of alternative telesurgical toolsof different types and differing end effectors 230 may be used, with thetools of at least some of the manipulators being removed and replacedwith another tool during a surgical procedure. As the manipulator moves,the tool moves as a whole. The manipulator optionally also providesmechanical input to the tool in order to move one or more toolcomponents, such as an end effector. Optionally, a tool may include oneor more motors that move an associated one or more tool components. Andso, some DOFs are associated with moving the tool as a whole (e.g., toolpitch or yaw about the remote center of motion, tool insertion andwithdrawal through the remote center of motion), and some DOFs areassociated with moving a tool component (e.g., rolling the end effectorby rolling the shaft, end effector pitch or yaw with respect to theshaft, etc.). A tool's end effector is moved by both these types ofDOFs, often working in concert to perform the desired end effector posechange in space. It can be seen that the manipulator arm assemblies 120,130, 140, and 150 will often undergo significant movement outsidepatient during a surgical procedure in order to move a correspondingtool end effector as commanded by the corresponding master input device.

End effectors may include first and second end effector elements 56 a,56 b which pivot relative to each other so as to define a pair of endeffector jaws, for example DeBakey Forceps 56 i, microforceps 56 ii, andPotts scissors 56 iii. Other end effectors may have a single endeffector element, for example scalpels and electrocautery elements. Fortools having end effector jaws, the jaws will often be actuated bysqueezing grip members on master input devices 41, 42. Other endeffector mechanical DOFs may include functions such as stapleapplication, clip application, knife blade movement, and the like.

Referring to FIG. 8, an example telesurgical system 500 includes asurgical tool 600, a surgical tool actuator assembly 700 (also referredto herein as a “pod”), and a manipulator assembly 800. Pod 700 iscompatible with tool 600, and tool 600 is removably coupled to Pod 700.Pod 700 is coupled to manipulator assembly 800. In some embodiments, thepod 700 is readily detachable from the manipulator assembly 800 suchthat the pod 700 can be conveniently interchanged with another pod. Themanipulator assembly 800 can be adjustably mounted to a frame or astructure (such as the set-up structure 172 of FIG. 4). Manipulatorassembly 800 and pod 700 together form a manipulator.

When surgical tool 600 is coupled with pod 700, a shaft 640 of thesurgical tool 600 slidably extends through a cannula 400 that isreleasably coupled to the manipulator assembly 800. In use, the cannula400 can extend through a patient's body wall or natural orifice.Surgical tool 600 includes an end effector 650 that is controlled by theuser operating a master input device to perform telesurgery.

Pod 700 defines a space configured to receive surgical tool 600. Whenthe surgical tool 600 is coupled pod 700, pod 700 can actuate movementsof the surgical tool 600 as a whole and movements of the end effector650 with reference to the main body of the tool. For example, the pod700 can actuate translational movements of the surgical tool along thelongitudinal axis 702 of the pod 700 to insert or withdraw the endeffector. Hence, the longitudinal axis 702 may also be referred to asthe insertion axis 702, which is coincident with tool 600's long axis.

The manipulator assembly 800 includes a mounting base 810, an arm 820, atool actuator assembly coupling 840 (a “pod coupling”), and a drive link850. The mounting base 810 is configured to releasably couple with aset-up structure of a telesurgical system (such as the set-up structure172 of FIG. 4). The arm 820 is rotatably coupled to the mounting base810 to rotate about axis 802.

Pod coupling 840 is configured to releasably couple with pod 700, and itis movably coupled with the arm 820 such that pod coupling 840 istranslatable along an arcuate path defined by the arm 820 (a “pitcharc”). As shown, the pitch arc 842 is defined in a distal portion of arm820.

The drive link 850 is movably coupled between the arm 820 and the podcoupling 840. A first end of the link 850 is coupled to an actuator ofthe arm 820. A second end of the link 850 is coupled to the pod coupling840. Hence, an actuator in arm 820 drives pod coupling 840 along thepitch arc 842 via drive link 850.

The telesurgical system 500 is configured to actuate pitch, roll, andyaw motions of the surgical tool 600 in response to input (e.g., userinput using the control subsystem 40 as described in reference to FIG.2). For example, the arm 820 is rotatably coupled to the mounting base810 such that the arm 820 can be controlled to rotate about yaw axis 802in relation to mounting base 810, as indicated by arrows 804. Inaddition, the tool actuator assembly coupling 840 is movably coupled tothe arm 820 such that the tool actuator assembly coupling 840 can becontrolled to translate along pitch arc 842 as indicated by arrows 844.Further, at pod coupling 840, pod 700 is rotatable about insertion axis702 in relation to the arm 820, as indicated by arrows 704. As shown, insome embodiments pod coupling 840 includes a motor 846 that drives pod700 rotation about axis 702.

In some embodiments (such as the depicted embodiment), the insertionaxis 702 and the yaw axis 802 intersect each other at a center point ofthe pitch arc 842 to define a remote center of motion 502. The remotecenter of motion 502 is a point in space around which the roll, pitch,and yaw motions described above are made. For example, as the arm 820 isrotated in relation to the mounting base 810 to generate a yaw motion ofthe surgical tool 600, the position of the remote center of motion 502is unchanged because the yaw axis 802 passes through the remote centerof motion 502. In addition, as the pod coupling 840 is translated inrelation to the arm 820 along the pitch arc 842 to generate a pitchmotion of the surgical tool 600, the position of the remote center ofmotion 502 is unchanged because the center point of the pitch arc 842 islocated at the remote center of motion 502. Further, as the pod 700 isrotated in relation to the arm 820 about the insertion axis 702 togenerate a roll motion of the surgical tool 600, the position of theremote center of motion 502 is unchanged because the insertion axis 702passes through the remote center of motion 502. Hence, it can be saidthat telesurgical system 500 is a hardware-constrained remote center ofmotion system.

In use, the remote center of motion 502 (which is typically at alocation coincident with a region of the cannula 400) may be positionedat the patient's body wall or natural orifice. One advantage of such anarrangement is that while the surgical tool 600 undergoes roll, pitch,and yaw motions, the resulting trauma applied to the body wall by thecannula 400 is reduced or eliminated because the portion of the cannula400 (at the remote center of motion 502) that interfaces with the bodywall moves a relatively small amount while the surgical tool 600undergoes the roll, pitch, and yaw motions.

Further, in regard to the hardware-constrained remote center of motion,it should be understood that at all pod 840 positions along pitch arc842, the insertion axis 702 and the yaw axis 802 intersect each other atthe center of the pitch arc where the remote center of motion 502 islocated. In addition, at all positions about the yaw axis 802 of the arm820 relative to the mounting base 810, the insertion axis 702 and theyaw axis 802 intersect each other at the center of the pitch arc wherethe remote center of motion 502 is located. Further, at all positions ofthe pod coupling 840 along the pitch arc 802 in combination with anyposition about the yaw axis 802 of the arm 820 relative to the mountingbase 810, the insertion axis 702 and the yaw axis 802 intersect eachother at a center of the pitch arc where the remote center of motion 502is located.

Referring also to FIG. 9, pod 700 is shown in isolation from thesurgical tool 600 and the manipulator assembly 800. Pod 700 includes aproximal end 704 and a distal end 706, and the longitudinal axis 702 isdefined between these proximal and distal ends.

In the depicted embodiment, the pod 700 includes a proximal end plate705, a distal end plate 707, and a housing 710. The housing 710 extendsbetween the proximal end 704 and the distal end 706.

In the depicted embodiment, the proximal end plate 705 is a C-shapedplate, and the distal end plate 707 is a fully circumferential platethat defines an open center. The opening in the proximal end plate 705aligns with a slot opening 712 defined by the housing 710. The slotopening 712 and the opening in the C-shaped proximal end plate 705provide clearance for a handle 612 of the surgical tool 600 to projectradially from the housing 710 while the surgical tool 600 is coupledwith the tool drive system 700.

In the depicted embodiment, pod 700 also includes a roll driven gear 708located at the distal end 706. The pod's roll driven gear 708 can meshwith and be driven by a roll drive gear 847 (refer to FIGS. 13, 17, and19) coupled to a roll drive motor 846 of the pod coupling 840 when thepod 700 is coupled with the manipulator assembly 800. When the rolldrive gear 847 drives the roll driven gear 708, the entire pod 700rotates to roll about the longitudinal axis 702. As a result, when thesurgical tool 600 is engaged with the pod 700, the surgical tool 600 asa whole also rotates to rolls about the longitudinal axis 702 (i.e.,about shaft 640). Alternatively, in some embodiments, a roll drive motor(to which a roll drive gear is coupled) is a component of the pod 700,and a roll driven gear is a component of the pod coupling 840. The rolldriven gear can be fixed to the pod coupling 840 in some embodiments. Insuch an arrangement, when the roll driven gear is driven by the rolldrive motor, the entire pod 700 rotates to rolls about the longitudinalaxis 702. Rotating the tool as a whole rotates the tool's end effector,and so the tool may be simplified by eliminating an end effector DOF forroll with reference to the main body of the tool.

Referring also to FIGS. 10, 12, and 14, the example manipulator assembly800 is shown in isolation from the surgical tool 600 and the pod 700. Inthe example embodiment, it can be seen that the proximal end of mountingbase 810 includes a ball configured to releasably couple with acorresponding socket in a set-up structure of a telesurgical system(such as the set-up structure 172 of FIG. 4). The ball and socket form aspherical joint that advantageously allows the mounting base to be posedin various ways to align with a cannula for surgery. In otherembodiments, other joint configurations may be used between themanipulator and the setup portion of the arm.

In the depicted embodiment, the pod coupling 840 includes roll drivemotor 846 that drives pod 700 to rotate about insertion axis 702. Anopen interior space is defined in pod coupling 840. This open spacereceives pod 700's distal end portion 706 and is aligned with insertionaxis 702 when pod 700 is mounted on pod coupling 702. Inserting pod700's distal end portion 706 engages the pod with roll drive motor 846,which may then drive pod 700 to roll about insertion axis 702. Detailsof roll drive motor 846 placement are discussed further below.

The link 850 is movably coupled between the arm 820 and the pod coupling840. A first end of the link 850 is coupled to an actuator (e.g., alinear actuator) of the arm 820. A second end of the link 850 is coupledto the pod coupling 840. Hence, the pod coupling 840 is driven along thecurvilinear path of the pitch arc 842 by the link 850 that is driven byan actuator of the arm 820. Various linear actuator types may be used,including motors that drive lead or ball screws with threaded nuts thattranslate as the screw turns, chain or belt drives, hydraulic orpneumatic actuators, electromagnetic or piezo electric linear drives,and the like.

Referring also to FIGS. 11, 13, and 15, portions of the examplemanipulator assembly 800 are shown transparently so internal componentsof the manipulator assembly 800 can be visualized.

First, the mechanisms used for yaw motions of the manipulator assembly800 will be described. The arm 820 includes a cylindrical projection 822that extends into an internal space defined by the mounting base 810 andforms a roll joint between the arm and the mounting base. Spaced-apartyaw bearings 824 a and 824 b are disposed between the projection 822 andthe internal space defined by the mounting base 810 to provide for therotatable interface between base 810 and arm 820. The longitudinal axisof the cylindrical projection 822 defines the yaw axis 802. Ayaw-adjustment motor 826 is disposed within the arm 820, with an axis ofrotation parallel to and offset from yaw axis 802. A yaw drive gear 828is driven by the yaw-adjustment motor 826. The yaw drive gear 828 ismeshed with a yaw driven gear 806 that is affixed in a stationaryrelationship to the mounting base 810 and around yaw axis 802. In thedepicted embodiment, the yaw driven gear 806 is a sector gear (e.g., anarcuate gear rack) sufficient to accommodate the desired yaw range ofmotion. While the mounting base 810 is held stationary by a set-upstructure, actuation of the yaw-adjustment motor 826 will rotate the yawdrive gear 828, which will then travel along a circular path around theyaw driven gear 806 (i.e., around yaw axis 802). As a result, the arm820 will rotate about the yaw axis 802 in relation to the mounting base810. Optionally, however, a projection may extend from base 810 into arm820, and the components described above modified accordingly. And,optionally the motor and drive gear may be stationary in base 810 anddrive arm 820 to rotate.

Now the mechanisms used for pitch motions of the manipulator assembly800 will be described. The arm 820 includes a pitch-adjustment motor830. In the depicted embodiment, two pitch-adjustment motors 830 areganged together for greater torque, but two motors are not required inall embodiments. In some embodiments, a single pitch-adjustment motor830 is included. A pitch drive gear 832 coupled to the shaft of thepitch-adjustment motor 830 is rotated by the pitch-adjustment motor 830.A pitch driven gear 834 is driven by the pitch drive gear 832. In someembodiments, one or more intermediate gears may be positioned betweenthe pitch drive gear 832 and the pitch driven gear 834. The pitch drivengear 834 is affixed to a lead screw 836 that is rotatably coupled withinthe arm 820. Thus, the lead screw 836 is rotated about its longitudinalaxis as the pitch driven gear 834 is rotated by the pitch drive gear 832(which is rotated by the pitch-adjustment motor 830). A nut 838 isthreadably coupled with the lead screw 836. The nut 838 is restrainedfrom rotating along with the lead screw 836 as the lead screw 836 isrotating. Therefore, as the lead screw 836 rotates, the nut 838translates along the longitudinal axis of the lead screw 836. A firstend 852 of the link 850 is pivotably coupled to the nut 838. A secondend 854 of the link 850 is pivotably coupled to the pod coupling 840.Hence, as the nut 838 translates along the longitudinal axis of the leadscrew 836, the second end 854 of the link 850 drives translation of thepod coupling 840. Translations of the pod coupling 840 follow thecurvilinear path of the pitch arc 842. That is the case because the podcoupling 840 includes four bearings 848 that travel within arcuategrooves 821 defined within the arm 820. The arcuate grooves 821 definethe pitch arc 842. Other embodiments optionally use other pitch arcdesigns, such as a single arcuate groove with one or more bearings, oneor more arcuate rails with bearings on either side, one or more parallelarcuate rails with individual bearings inside each rail, one or morearcuate gear racks with mating pinions, one or more arcuate rods withone or more bearings sliding on the rod, and the like. And, other linearactuator types may be used, as described above.

Referring to FIGS. 16 and 17, yaw motions (as represented by arrow 804)of the example manipulator device 800 can be further visualized. Themounting base 810 is stationary (e.g., coupled to a set-up structure),and the arm 820 is rotatable about the yaw axis 802 in relation to themounding base 810.

The arm 820 includes the yaw-adjustment motor 826. The yaw drive gear828 is rigidly coupled to the shaft of the yaw-adjustment motor 826.Hence, actuation of the yaw-adjustment motor 826 will rotate the yawdrive gear 828. The yaw-adjustment motor 826 can rotatebi-directionally.

The yaw drive gear 828 is meshed with the yaw driven gear 806 that isaffixed in a stationary relationship to the mounting base 810 around theyaw axis 802. Since the mounting base 810 is held stationary by a set-upstructure, actuation of the yaw-adjustment motor 826 (which rotates theyaw drive gear 828) will cause the yaw drive gear 828 to travel along acircular path around the yaw driven gear 806. In result, the arm 820will rotate in relation to the mounting base 810 about the yaw axis 802.

In the depicted embodiment, the manipulator device 800 can rotatablyadjust through a range of about 160° of yaw motion. That is, the arm 820can rotate in relation to the mounting base 810 about the yaw axis 802through about 160° of travel. In some embodiments, the manipulatordevice 800 is configured to facilitate a range of yaw motion of about90° to about 130°, about 100° to about 140°, about 110° to about 150°,about 120° to about 160°, about 130° to about 170°, or about 140° toabout 180°. Yaw range of motion may be constrained by hardware (e.g.,the end of an arcuate rack, a physical hard stop between base and arm,and the like) or may be constrained by software control of motor 826.

Placing the manipulator assembly yaw and pitch actuator motors in arm820 advantageously allows base 810 to be relatively short, allows thepitch drive to be folded back on itself, and allows the yaw drive tooccupy the same length as the pitch drive for an overall compact arm andmanipulator assembly design.

Referring to FIGS. 18-20, pitch motions (as represented by arrow 844) ofthe example manipulator assembly 800 can be further visualized. Thepitch motions of the manipulator assembly 800 entail curvilineartranslational movements of the pod coupling 840 along the pitch arc 842as indicated by arrow 844.

The arm includes one or more pitch-adjustment motors 830 whichbi-directionally, rotatably drive the leadscrew 836. The nut 838 isthreadably coupled to the leadscrew 836 and is rotationally constrainedsuch that rotations of the leadscrew 836 result in translationalmovements of the nut 838. The first end 852 of the link 850 is pivotablycoupled to the nut 838. The second end 854 of the link 850 is pivotablycoupled to the pod coupling 840. Hence, as the nut 838 translates alongthe longitudinal axis of the lead screw 836, the second end 854 of thelink 850 drives translation of the pod coupling 840. Translations of thepod coupling 840 follow the curvilinear path of the pitch arc 842because the pod coupling 840 includes four bearings 848 that travelwithin the arcuate grooves 821 (FIGS. 11 and 13) defined within the arm820. The arcuate grooves 821 define the pitch arc 842. The four bearings848 are advantageously spaced apart from each other so as to providestructural stability and rigidity of the pod coupling 840 in relation tothe arm 820.

Forces from the surgical tool 600 and/or cannula 400 (FIG. 8) that aregenerally parallel with the insertion axis 702 are transferred to thearm 820 via the four spaced-apart bearings 848 that travel withinarcuate grooves 821 defined within the arm 820. Forces from the surgicaltool 600 and/or cannula 400 that are transverse to the insertion axis702, and torsional forces from the surgical tool 600 and/or cannula 400,are transferred to the arm 820 via multiple bearings 849. The bearings849 are rotatably coupled to the pod coupling 840 and roll on innerplanar surfaces of the arm 820. In the depicted embodiment, eightbearings 849 are included (four on each side of the pod coupling 840that rides within the distal arcuate portion of the arm 820). Theseeight bearings 849 are spaced apart from each other to advantageouslyprovide structural stability and rigidity of the pod coupling 840 inrelation to the arm 820. In some embodiments, more or fewer than eightbearings 849 are included. For example, in some embodiments two, three,four, five, six, seven, nine, ten, eleven, twelve, or more than twelvebearings 849 are included.

The center point of the radius 843 of the pitch arc 842 is coincidentwith the remote center of motion 502. Hence, pitch motions of themanipulator device 800 are made about the remote center of motion 502because the center point of the radius 843 of the pitch arc 842 iscoincident with the remote center of motion 502.

In the depicted embodiment, the manipulator device 800 can adjustthrough a range of about 80° of pitch motion. That is, the pod coupling840 can translate in relation to the arm 820 along the pitch arc 842through about 80° of travel. In some embodiments, the manipulator device800 is configured to facilitate a range of pitch motion of about 50° toabout 70°, about 60° to about 80°, about 70° to about 90°, about 80° toabout 100°, about 90° to about 110°, or about 100° to about 120°. Rangeof motion may be constrained by physical hard stop, such as reaching theend of an arcuate groove or a dedicated mechanical stop, or it may beconstrained by software control of the motor.

The range of pitch motion of the manipulator device 800 isadvantageously facilitated in part by the configuration of the link 850.That is, the second end 854 of the link 850 is forked to provideclearance for the roll-adjustment motor 846 to travel within the spacebetween the forks while the pod coupling 840 is positioned in relationto the arm 820 as shown in FIGS. 10-11, 14-16, and 18-20. Placing theroll drive motor 846 proximally on the pod coupling 820 prevents themotor from projecting distally and interfering with another manipulatoror surgical tool or clinical personnel as the surgical tool is driven toits full pitch-back range of motion limit, and forking the link 850allows the motor to travel within the link to increase the surgicaltool's full pitch-forward range of motion limit. Alternatively, however,the roll drive motor may be placed distally or to the side on the podcoupling. And, rather than forking link 850, a non-forked single linkoffset to the side of motor 846, or two links on either side of link846, may optionally be used.

As described previously, the nut 838 is constrained from rotating. Onemechanism by which the nut 838 is so constrained also advantageouslyhelps prevent or reduce the exertion of undesirable lateral forces tothe leadscrew 836. In particular, the arm 820 defines two elongatelinear channels 839 (e.g., refer to FIG. 13) that extend parallel to theleadscrew 836 on opposite sides of the leadscrew 836. Two bearings 853are movably engaged within the two elongate linear channels 839. The twobearings 853 can be rotatably coupled with the nut 838 or with the firstend 852 of the link 850. This arrangement will transfer forces from thelink 850 (that would otherwise be exerted laterally to the leadscrew836) via the bearings 853 to the elongate linear channels 839.

In some embodiments, the manipulator assembly 800 may include electronicsensors and the like for various advantageous purposes. For example,encoders may be coupled to the drive trains of the motorized pitch,roll, and/or yaw adjustment mechanisms. In some embodiments, positionsensors may be used that can positively identify the locations of themovable components of the manipulator device 800.

Referring to FIG. 21, another example telesurgical system manipulator1100 includes the surgical tool 600 that is selectively coupleable witha compatible surgical tool actuator assembly 1000 (again, a “pod”) thatis, in turn, coupleable with an example manipulator assembly 900 to forma teleoperated tool manipulator. The configuration of surgical tool 600is as described above, and the description of pod 700 above generallyapplies to pod 1000, with certain differences noted in the descriptionbelow. Manipulator assembly 900 and its components are generally similarto manipulator assembly 800 and its components (e.g., base, arm, podcoupling) as described above, with certain differences noted in thedescription below. Cannula 1200 and its mounting is generally similar tocannula 400 described above. The remote center of motion 502 andassociated yaw, pitch, and insertion axes are as described above.

As shown in FIG. 21, the surgical tool actuator assembly coupling 940(again, a “pod coupling”) is movably coupled with the arm 920 such thatpod coupling 940 translates along an arcuate path 942 (again, the “pitcharc”) defined by the distal portion of arm 920. In the depictedembodiment the arcuate path 942 is defined by a combination of a fixedarcuate segment 922 (i.e., fixed in relation to other main portions ofthe arm 920) and a movable arcuate segment 926. The movable arcuatesegment 926 is movably coupled to the fixed arcuate segment 922 in atelescopic arrangement, as described further below in reference to FIGS.22-24.

The link 950 is similar to link 850 and is movably coupled between thearm 920 and the pod coupling 940. A first end of the link 950 is coupledto an actuator of the arm 920 that is similar to the pitch-adjustmentactuator of arm 820. A second end of the link 950 is coupled to podcoupling 940. Hence, pod 940 is driven along the curvilinear path of thepitch arc 942 by the link 950 that is driven by an actuator of the arm920.

The telesurgery surgery system 1100 is configured to actuate yaw, pitch,and roll motions of surgical tool 600 in response to user input asdescribed above, with arm 820 rotating around associated yaw axis 902(arrows 904), pod coupling 940 translating along pitch arc 942 (arrows944), and pod 1000 rotating around insertion axis 1002 (arrows 1004). Asdescribed above, pod 1000 controls tool insertion and withdrawal alongaxis 1002 and tool 600 distal component movements.

Referring also to FIGS. 22-24, pitch motions (as represented by arrows944) of the example manipulator assembly 900 will now be furtherdescribed. The pitch motions of the manipulator device 900 entailcurvilinear translational movements of the pod coupling 940 along thepitch arc 942 as depicted by arrows 944. In these figures, the arm 920is shown transparently so that mechanisms internal to the arm 920 can bevisualized.

In the depicted embodiment, the arcuate path 942 is defined by thecombination of a first, fixed arcuate segment 922 and a second, movablearcuate segment 926. The movable arcuate segment 926 is movably coupledto the fixed arcuate segment 922 so that the movable segment 926telescopes distally with reference to fixed segment 922. As shown,movable segment 926 is positioned and translates inside fixed segment922, and optionally movable segment 926 is positioned and translatesoutside fixed segment 922. Such a telescoping arrangement offersadvantages. For example, as shown in FIGS. 22 and 23, the telescopicarrangement of the arcuate segments 922 and 926 allows the overalllength of the manipulator assembly 900 to be shorter as compared to anarm that has only a fixed arcuate portion with the same pitch range ofmotion). Having a shorter overall length can advantageously reduce thepotential for collisions between manipulator assemblies (e.g., when twoor more manipulator assemblies are used during a surgery as depicted inFIG. 4). Additionally, shortening overall length of the manipulatorassembly 900 allows for enhanced patient access by clinical personneland more flexibility in manipulator positioning in relation to thepatient.

As described above for arm 820, arm 920 includes one or morepitch-adjustment motors 930 which bi-directionally, rotatably drive aleadscrew 936. A nut 938 is threadably coupled to the leadscrew 936 andis rotationally constrained such that rotations of the leadscrew 936result in translational movements of the nut 938. The first end 952 ofthe link 950 is pivotably coupled to the nut 938. The second end 954 ofthe link 950 is pivotably coupled to the pod 940. Hence, as the nut 938translates along the longitudinal axis of the lead screw 936, the secondend 954 of the link 950 drives translation of the pod coupling 940 tofollow the curvilinear path of the pitch arc 942. The sequence of FIGS.22-24 illustrate pod coupling 940 translating along pitch arc 942, aswell as movable segment 926 telescoping in relation to fixed segment922.

As shown in FIG. 22, in a full surgical tool pitch-forward configurationthe pod coupling 940 is located at its proximal end range of motionlimit in relation to the movable arcuate segment 926, and the movablearcuate segment 926 is located at its proximal end range of motion limitin relation to the fixed arcuate segment 922. As the link 950 is drivendistally in relation to the arm 920, the pod coupling 940 first beginsto translate distally along a curvilinear path defined by the movablearcuate segment 926 while the movable arcuate segment 926 remainsstationary in relation to the fixed arcuate segment 922. As shown inFIG. 23, in the configuration in which the pod coupling 940 has reachedits distal range of motion limit in relation to the movable arcuatesegment 926, the movable arcuate segment 926 begins to move distally inrelation to the fixed arcuate segment 922. As the link 950 is drivenstill farther distally in relation to the arm 920, the movable arcuatesegment 926, with the pod coupling 940 remaining at its distal range ofmotion limit in relation to the movable arcuate segment 926, translatesdistally along a curvilinear path defined by the fixed arcuate segment922 until the movable arcuate segment 926 its distal range of motionlimit in relation to the fixed arcuate segment 922, as depicted in FIG.24.

A proximal retraction of the movable arcuate segment 926 and the podcoupling 940 to their proximal range of motion limits (e.g., moving fromthe configuration of FIG. 24 toward the configuration of FIG. 23, andfurther toward the configuration of FIG. 22) can take place as areversal of the above-described sequence of distal movements. In someembodiments, the movable arcuate segment 926 is spring-biased towardsits proximal end range of motion limit in relation to the fixed arcuatesegment 922. Accordingly, movable segment 926 remains at its proximalrange of motion limit as link 950 drives pod coupling 940 through theproximal portion of pod coupling's full pitch range of motion (e.g.,FIG. 22). As link 950 drives pod coupling 940 beyond its distal range ofmotion limit within movable link 926 (e.g., FIG. 23), thepitch-adjustment actuator overcomes the spring bias, and movable link926 and pod coupling 940 together begin to translate distally alongfixed segment 922 to move pod coupling 940 through the distal portion ofpod coupling 940's full pitch range of motion (e.g., FIG. 24).

During retraction, the link 950 is retracted proximally (starting fromthe configuration of FIG. 24), and the spring bias keeps the movablearcuate segment 926 against pod coupling 940. When the movable arcuatesegment 926 reaches its proximal range of motion limit in relation tothe fixed arcuate segment 922, then the pod coupling 940 will begin totranslate proximally along the curvilinear path defined by the movablearcuate segment 926 until the pod coupling 940 reaches its proximalrange of motion in relation to the movable arcuate segment 926.

In some embodiments, the extension and retraction movements of themovable arcuate segment 926 in relation to the fixed arcuate segment 922can be motorized. A separate motorized linear actuator drives movablearcuate segment through its arcuate range of motions. In someembodiments, other telescoping or telescoping actuator arrangements maybe used to control the movable segment's position with reference to thefixed segment as the pod coupling is moved distally and proximally withreference to the fixed and movable segments.

The bearing arrangements used to movably couple the pod coupling 940with the movable arcuate segment 926, and to movably couple the movablearcuate segment 926 with the fixed arcuate segment 922, are analogous tothe bearing arrangements used to movably couple the pod coupling 840with the arm 820 as described above in reference to the manipulatorassembly 800 (see, e.g., FIGS. 18-20). That is, a first group ofmultiple bearings (e.g., four bearings) are affixed to pod coupling 940and travel in the arcuate grooves defined in movable segment 926, and asecond group of multiple bearings (e.g., four bearings) are affixed tomovable segment 926 and travel in the arcuate grooves defined in fixedsegment 922. Likewise, a first group of lateral bearings (e.g., fourbearings) are affixed to pod coupling 940 and bear against one or moreinner planar surfaces of movable segment 926, and a second group oflateral bearings (e.g., four) are affixed to movable segment 926 andbear against one or more inner planar surfaces of fixed segment 922.Such bearing arrangements can advantageously provide structuralstability and rigidity of the pod coupling 940 in relation to themovable arcuate segment 926, and of the movable arcuate segment 926 inrelation to the fixed arcuate segment 922 (as described above inreference to the bearing arrangements between the pod coupling 840 andthe arm 820).

As described above for manipulator assembly 820, other arcuatemechanisms that include two or more arcuate grooves, or one or morearcuate rails, or one or more arcuate rods, etc. may be used in otherembodiments.

In the depicted embodiment, the manipulator device 900 can adjustthrough a range of about 80° of pitch motion. That is, the pod coupling940 can translate in relation to the arm 920 along the pitch arc 942through about 80° of travel. In some embodiments, the manipulator device900 is configured to facilitate a range of pitch motion of about 50° toabout 70°, about 60° to about 80°, about 70° to about 90°, about 80° toabout 100°, about 90° to about 110°, or about 100° to about 120°.

As described previously, the nut 938 is constrained from rotating. Onemechanism by which the nut 938 is so constrained also advantageouslyhelps prevent or reduce the exertion of undesirable lateral forces tothe leadscrew 936. In particular, the arm 920 defines two elongatelinear channels that extend parallel to the leadscrew 936 on oppositesides of the leadscrew 936. Two bearings 953 are movably engaged withinthe two elongate linear channels 939. The two bearings 953 can berotatably coupled with the nut 938 or with the first end 952 of the link950. This arrangement will transfer forces from the link 950 (that wouldotherwise be exerted laterally to the leadscrew 936) to the elongatelinear channels of the arm 920 via the bearings 953.

Referring again to FIG. 21, it can be seen that the depicted manipulator1100 does not explicitly show a pod roll motor analogous to motor 846shown for example in FIG. 8 above. Although not explicitly shown, ananalogous pod roll motor may be implemented in some embodiments. And insome embodiments with both fixed and telescoping pitch arcs, an internalpod roll motor may be used. For example, when pod 1000 is mounted to podcoupling 940 (or pod 700 to pod coupling 840), the internal pod rollmotor rolls the pod around insertion axis.

In some embodiments, the manipulator device 900 may include electronicsensors and the like for various advantageous purposes. For example,encoders may be coupled to the drive trains of the motorized pitch,roll, and/or yaw adjustment mechanisms. In some embodiments, positionsensors may be used that can positively identify the locations of themovable components of the manipulator device 900.

While this specification contains many specific implementation details,these should not be construed as limitations on the scope of anyinvention or of what may be claimed, but rather as descriptions offeatures that may be specific to particular embodiments of particularinventions. Certain features that are described in this specification inthe context of separate embodiments can also be implemented incombination in a single embodiment. Conversely, various features thatare described in the context of a single embodiment can also beimplemented in multiple embodiments separately or in any suitablesubcombination. Moreover, although features may be described herein asacting in certain combinations and even initially claimed as such, oneor more features from a claimed combination can in some cases be excisedfrom the combination, and the claimed combination may be directed to asubcombination or variation of a subcombination.

Similarly, while operations are depicted in the drawings in a particularorder, this should not be understood as requiring that such operationsbe performed in the particular order shown or in sequential order, orthat all illustrated operations be performed, to achieve desirableresults. In certain circumstances, multitasking and parallel processingmay be advantageous. Moreover, the separation of various system modulesand components in the embodiments described herein should not beunderstood as requiring such separation in all embodiments, and itshould be understood that the described program components and systemscan generally be integrated together in a single product or packagedinto multiple products.

Particular embodiments of the subject matter have been described. Otherembodiments are within the scope of the following claims. For example,the actions recited in the claims can be performed in a different orderand still achieve desirable results. As one example, the processesdepicted in the accompanying figures do not necessarily require theparticular order shown, or sequential order, to achieve desirableresults. In certain implementations, multitasking and parallelprocessing may be advantageous.

We claim:
 1. A teleoperated manipulator system comprising: a mounting base defining a yaw axis; an arm coupled to the mounting base and rotatable relative to the mounting base around the yaw axis, the arm comprising an arcuate pitch arc portion defining a pitch arc; a cannula movably coupled to the pitch arc portion at a location that is movable along the pitch arc relative to the mounting base; a tool actuator assembly coupled to the arm at an end of the arm opposite of the mounting base; and a surgical instrument including a shaft, an end effector at a distal end of the shaft, and a proximal end portion releasably coupled to the tool actuator assembly, the shaft slidably coupled with the cannula and defining an insertion axis along a long axis of the shaft, wherein the tool actuator assembly is arranged to actuate movements of the end effector and to translate the surgical instrument along the insertion axis relative to the cannula, wherein the tool actuator assembly comprises a roll-adjustment actuator coupled to and movable relative to the arm, the roll-adjustment actuator arranged to drive rotations of the shaft about the insertion axis, and wherein the yaw axis and the insertion axis intersect at a center of the pitch arc to define a remote center of motion of the manipulator system.
 2. The teleoperated manipulator system of claim 1, wherein: the arm includes a projection extending into the mounting base to define a roll joint having an axis of rotation; and the axis of rotation of the roll joint defines the yaw axis.
 3. The teleoperated manipulator system of claim 1, wherein: the mounting base is configured to releasably couple to a setup arm configured to hold the mounting base stationary in space.
 4. The teleoperated manipulator system of claim 1, wherein: the tool actuator assembly comprises a plurality of motors.
 5. The teleoperated manipulator system of claim 1, wherein: the tool actuator assembly is configured to actuate movable components of the surgical instrument.
 6. The teleoperated manipulator system of claim 1, wherein: the pitch arc portion of the arm comprises a fixed arcuate segment and a movable arcuate segment coupled to the fixed arcuate segment, the fixed arcuate segment and the movable arcuate segment together defining the pitch arc; the movable arcuate segment is coupled to translate on a curvilinear path in the fixed arcuate segment; and the tool actuator assembly is coupled to translate on a curvilinear path in the movable arcuate segment.
 7. The teleoperated manipulator system of claim 6, wherein: the arm comprises a spring positioned to bias the movable arcuate segment to a proximal end of a range of motion of the movable arcuate segment on the curvilinear path in the fixed arcuate segment.
 8. The teleoperated manipulator system of claim 1, wherein: the mounting base comprises a sector gear; the arm comprises a yaw-adjustment motor and a pinion gear coupled to the motor, the pinion gear being engaged with the sector gear of the mounting base; and the yaw-adjustment motor drives the arm about the yaw axis.
 9. The teleoperated manipulator system of claim 1, wherein: the arm comprises a yaw-adjustment motor having an axis of rotation parallel to and offset from the yaw axis; and the yaw-adjustment motor drives the arm about the yaw axis.
 10. The teleoperated manipulator system of claim 1, wherein: the tool actuator assembly coupling comprises a first gear coupled to the roll-adjustment actuator; the tool actuator assembly comprises a second gear coupled to the first gear; and rotation of the first gear drives the tool actuator assembly to rotate around the insertion axis.
 11. The teleoperated manipulator system of claim 1, wherein: the tool actuator assembly is interchangeable with a second tool actuator assembly. 